Ovarian stimulation in infertile women treated with the use of intrauterine insemination: a cohort study from China

Abstract

To study the effectiveness of different ovarian stimulation protocols compared with natural cycle treatment in an intrauterine insemination (IUI) program. Retrospective cohort study. Large reproductive medicine center. Couples with unexplained or mild male-factor infertility. Couples were treated with the use of natural-cycle IUI, or IUI after ovarian stimulation with the use of clomiphene citrate (CC), letrozole, or gonadotropins. Live birth, multiple pregnancy rates, and cumulative live birth rates after three IUI cycles. We performed 14,519 IUI cycles in 8,583 couples. Compared with natural-cycle IUI (6.2%), live birth rates were significantly higher in IUI cycles stimulated with the use of CC (8.9%), letrozole (9.4%) and gonadotropins (9.5%). The multiple pregnancy rate resulting from natural cycles was 0.7%, compared with 4.6% in CC cycles, 1.3% in letrozole cycles, and 4.2% in gonadotropin cycles. Cumulative live birth rates after three IUI cycles were 18.4% after natural-cycle IUI, and 25.7%, 26.2%, and 23.7% with the use of CC, letrozole, and gonadotropins, respectively. In an IUI program for unexplained or mild male-factor infertility, ovarian stimulation with letrozole may significantly increase live birth rates while controlling multiple pregnancy rates.